Acupuncturists without Borders Responds to Nepal Earthquake

Photo of  William Wulsin, ND, MPH, LAcThe email arrived on April 29, 2015, amidst additional news of the 10,000-plus deaths in Nepal and the devastation at Everest base camp following the 7.8-magnitude earthquake. The sender was William Wulsin, ND, MPH, LAc (pictured), a Seattle, Washington–based healthcare professional with long ties to Nepal. Besides work on international projects through his Health Development Resources consulting, Wulsin has repeatedly provided healthcare services in disaster-stricken zones: Katrina, Haiti, and the 2014 Oso mudslide in his native Washington State.  The chief therapeutic tool is five-needle ear acupuncture protocol promulgated through the National Acupuncture Detoxification Association (NADA). The NADA treatment, delivered typically in groups, can support individuals amidst the overwhelming stress of such disasters. Wulsin notes that the protocol is also known to “mitigate the onset of posttraumatic stress disorder (PTSD).” He wrote with an appeal for financial investment to back his personal investment of time to “go to Nepal in May and June to assist coordination of healthcare teams in the Kathmandu Valley and rural communities hit hardest by the earthquake.”

Logo for  Acupuncturists Without Borders (AWB)Wulsin’s trip, and those of his prospective coworkers, are being arranged through the not-for-profit Acupuncturists Without Borders (AWB). The organization grew out of spontaneous interests of many in service provision during the wreckage in the US state of Louisiana following Hurricane Katrina. AWB teams delivered more than 8,000 treatments. Since then, AWB and its members have facilitated response teams in many other wide-scale human traumas. They’ve trained hundreds of health workers to deliver the NADA protocol. Those interested in investing financially in these services in Nepal can contribute to AWB through this link with “Nepal Earthquake Relief” in the appropriate line.

Comment: The impotence one can feel at news of sudden disaster in distant places lifted for me when this note from Wulsin, a long-time colleague, arrived. The proximity for me of a recent family trip to Peru that included a visit with a weavers’ cooperative in a town at 13,500 feet brought immediacy given the striking similarities in these high mountain cultures. My professional awareness of NADA’s good work plus personal experience of the usefulness of group acupuncture left me no question as to the utility of the services. I spoke with my spouse. We decided to make what was for us a generous investment in this global, human-to-human connection. Perhaps others of you may feel similarly and wish to invest. Here again is the link to this one global advance in health and medicine.

Traditional Medicine in Universal Health Care: The Powerful Perspective in the WHO Strategic Plan

The World Health OrganizationThe World Health Organization’s (WHO’s) Traditional Medicine Strategy 2014-2023 may be most remarkable for its positioning of traditional and complementary medicine (T&CM) “products, practices, and practitioners” – a repeat phrase in the document—as part of the WHO mission of establishing “universal health care” (UHC). The top goal is “harnessing the potential contribution of T&CM to health, wellness, people-centered care, and UHC” (p 43). One of three strategic objectives is more explicit. Traditional products and services are viewed as levers in “promoting universal health coverage by integrating T&CM services and self-health care into national health systems” (p 8). The strategy explicitly recommends that this means “integration into the national health system including reimbursement, potential referral, and collaborative pathways.”

Throughout, the document suggests that T&CM can be significant contributors to a key need: cost savings. Two European studies are referenced (p 29). Demand for T&CM is associated with concern about escalating costs (p 25). Its “economic importance” is framed in part as a role in “actually reducing healthcare costs” (p 18). For those familiar with the move toward “values-based” medicine in the United States as evidenced in the Triple Aim, the strategy urges WHO member nations to examine how T&CM can lead not only to cost savings but also to the other two legs of the Triple Aim stool: “how T&CM may improve patient experience and population health” (p 19).

Comment: I was honored to be part of two of the four working groups (the second in 2012, and fourth in 2013) assembled by WHO to support preparation of the strategy. In that capacity, one is also quite aware that the distance between dialogue, decision, and dissemination is one marked by multiple other interventions. Still, it is pleasing and remarkable to see WHO take T&CM so seriously. That some 80% of many populations is believed to use traditional medicine for part of their primary care certainly drives this embrace. The data increasingly support this general direction. See the studies referenced at the Project for Integrative Health and the Triple Aim.

IHIAt the same time, the movement in the United States and other nations with awfully expensive and overdeveloped medical industries toward the outpatient services, self-care, community partnerships, and the determinants of health suggest that global health is trending toward less separation between traditional and industrial practices. Talk about “transforming” the medical system in industrial nations from the present bullying leadership by the tertiary care segment is wonderfully captured in the WHO strategy. The authors write that the “predominance of curative, hospital-based, disease-oriented services” is “poorly integrated into the broader health systems” (p 35).

The systems thus presented are already flipped. Communities are the base rather than the institutions in nations where the determinants of ill health include excessive invasiveness and over-production of services that may account for, in the United States alone, more than 250,000 deaths a year. While policy wonks in most developed nations will likely look down their noses at this plan as a tool, at best, for the less developed, those seeking to drive transformation may find in this strategy multiple useful directions.

Note:
From time to time, I will return to this WHO document for additional perspectives. Please feel free to share with me your views on the value (or not) in the strategy.

India Report: Announcement of Department of AYUSH Promotes Flurry of Activity

Note: From time to time the Global Integrator will pull together Quick Links on a theme or a single nation’s activities. This posting regards robust developments in India.

Indian Prime Minister Narendra ModiThe fall 2014 decision by  Indian Prime Minister Narendra Modi (pictured) to create a Department of AYUSH has stimulated a flurry of activity in that country. The move has both internal and external ramifications. The need for more alternatives was promoted by Union Minister of Health and Family Welfare head Shripad Yesso Naik at this Indian conference. The government has spoken of the intention to raise the role of traditional practices in the nation’s health plans. India’s Union home minister has noted that alternative medicine is part of the plan for a vast expansion of medical education facilities and medical care access. It is also part of an export strategy. The nation’s ambassador to Egypt used the declaration of the AYUSH ministry to link the disappearance of traditional methods in many countries to colonialism and to suggest the possibility of cross-cultural training.

The central government has announced that it will financially support a new Ayurvedic clinical research center on 50 acres in Kerala to help “scientifically validate traditional systems of healing.” The center will include a strong biotech unit. The government’s goal is to expand the already robust market for Ayurvedic medicine 5-fold by 2020. Apparently, the Indian complex will also include India’s first center for the interdisciplinary study of medicine, the Amrita Institute for Integrated Medicine and Research Center.

Mazumdar Cancer Centre launched a department of integrative oncology at Narayana Health City. Meantime, the Indian Society of Pharmacognosy called for increased exploration of traditional medicine at its 2015 meeting. The National Medicinal Plants Board inside the AYUSH Ministry is taking on the challenge of regulations relative to the use of endangered medicinal plants.  Internal jealousy was apparently provoked by the creation of the department. Siddha practitioners urged their fellows “to put a strong demand before the state government and to the central AYUSH ministry for establishing a separate Ministry for Siddha.”

Photo Doordashan and the department of AYUSHIndian television is being put to use by the government to fan interest. A collaboration between Indian national network Doordashan and the department of AYUSH led to a weekly television call-in show on traditional medicine.  The activity has not been without push-back. There is a call for a crackdown on “two types of quacks”. These are defined, on one hand, as Siddha, Ayurveda and Unani doctors who prescribe allopathic medicines or administer injections. One the other are those who reportedly claim to be traditional medicine practitioners but meet no standards. The not-altogether-friendly title of “Eat, Pray, Leeches” was placed on this feature overview on the new direction.

Recent reports have provided some dimensions to the industry. For instance, the country reportedly has over 2,300 spas generating $400-million in revenue. That market is growing 20% a year, according to this report. A state-by-state look at national products manufacturing finds “9,000 total manufacturing units.”  A good overview of the Indian government’s plans with its AYUSH department and the globalization of Ayurveda is here.

Comment: In recent years I have captured similar quick links to the robust integrative medicine activities in the United States – for instance here for February 2015. News from India speaks to a renaissance there that will continue to intrigue for how traditional medicines may be better incorporated at home, and also in the promotion of these practices and products as global contributors to health and medicine.

British Official Acts against Public, WHO, Prior Recommendations, and Will Not Regulate Herbalists

Photo of David Walker, MDIn a controversial move reported here, David Walker, MD (pictured), Britain’s deputy chief medical officer, decided that there is “insufficient evidence that the alternative therapy works, making it impossible to set standards of good practice.” Therefore, Great Britain will not create a “statutory register of herbal practitioners.” Walker believes herbalists would need to be “more science and evidence-based” to merit regulation.  The registry would have included Western herbs and Chinese medicines. While acting against regulation of the practitioners, Walker calls “for a review of all ingredients sold in such medicines, to check their safety.” To this he would add a “voluntary register” for practitioners.

The action was presented as a policy “U-turn.” It followed two public consultations and three prior committees that found “overwhelming support” for regulation. A call for regulation goes back 15 years. Prince Charles lobbied for regulation. Pro and con arguments bounce from the idea that regulation would confer inappropriate legitimacy on herbalists to a view that failure to create the registry is a risk to the public health from unregulated herbal practices. The divisive nature of the topic was hardly put to rest. Twelve of the 26 members of the ruling party signed a letter opposing Walker’s recommendation.

Logo for European Herbal and Traditional Medicine Practitioners AssociationMichael McIntyre, chairman of the European Herbal and Traditional Medicine Practitioners Association, said, “We are deeply disappointed by this. We feared this issue was going to be kicked into the long grass, by quietly putting something out just before the election—and that is exactly what has happened.” The association’s response to Walker’s report is here.

Comment: The news reminds me of the joke about hiring an economist. Asked what 1 + 1 is, the economist who gets the job answers, “What do you want it to be?” Three committees said evidence added up to regulation. Now, finally, Walker apparently found the kind of addition he liked in this report.  Significantly, this decision was made in the context of a 2014-2023 WHO Traditional Medicine Strategy that calls for better “integrating traditional and complementary medicine services into health services delivery.” The WHO document not only promotes increased regulation of “products, practices, and practitioners” but also “integration into the national health system including reimbursement.”

For reference, the United States offers a mixed picture on regulation of herbalists. Practitioners of traditional Chinese medicine are licensed in almost all 50 states. The still small (5,000-6,000) profession of naturopathic doctors, with their extensive training in botanicals, is regulated in just 18 states while it is promoted in others. Herbalists, on the other hand, as represented by the American Herbalists Guild, have chosen not to pursue licensing. They are not regulated in any jurisdiction.

Notably, Walker’s decision—based on a purported lack of evidence—came within weeks of a powerful statement from Josephine Briggs, MD, director of the NIH National Center for Complementary and Integrative Health, at the March 2015 annual meeting of the American Herbal Products Association. As reported in Holistic Primary Care’s NIH Center to Confront Fears of Drug-Herb Interactions, Briggs speaks to the potent and underutilized value of herbs. She lambastes overuse of drugs such as antibiotics and opioids and states, “Misplaced fear about herb-drug interactions is keeping many practitioners from recommending potentially beneficial botanical medicines.” Apparently, Briggs’ clarity becomes “insufficient evidence” on crossing the Atlantic.

Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for March 2015

Image of globe with computersThis monthly Global Integrator Blog entry highlights developments in traditional medicine and alternative and integrative health during a 1-month period. Here are 65 selections from around the globe—various with indigenous people in North America (including a huge integrative cancer center), challenges with regulation in Malaysia, an action on homeopathy by the US FDA, and much more—for the month of March 2015. What a wealth of activity!

  • The WHO recognition is announced in the Chinese publication with comments that TCM is practiced in 164 “countries and regions and includes 300,000 employees.”
  • A skeptical writer on the Obsession site notes that the World Federation of Chinese Medicine Societies has established WHO relations.
  • A collaboration between Indian national network Doordashan and the Indian department of AYUSH founded by Prime Minister Modi is leading to the launch of a weekly television call-in show on traditional medicine. A related article is here.
  • The Canadian Broadcasting Company has teed off against the way natural medicines are regulated.
  • One of 5 cooperation agreements signed between Mauritius and India relates to homeopathy and traditional medicine that “envisages exchange of experts, supply of traditional medicinal substances, joint research and development and recognition of the traditional systems of health and medicine in both countries. It also aims at promotion and popularisation of the various Indian traditional systems which fall under AYUSH.”
  • An inside look at the generations of traditional healers in the Hajji Rashid Lukwago herbal family, including real estate and herb school entrepreneur Sara Rashin Lukwago (pictured).
  • Australia’s National Health and Medical Research Council (NHMRC) has completed an extensive review of homeopathic literature and declared that no studies of sufficient size and design show homeopathy to be better than placebo: “From this review, the main recommendation for Australians is that they should not rely on homeopathy as a substitute for proven, effective treatments.” See Global Integrator article: Homeopathy on Trial (Again): Australian Report and Now USFDA April 20-21 Hearings.
  • When Fijian Minister of Health Jone Usamate visited India recently in a follow-up to signing a variety of accords, he briefed his Indian counterparts on Fijian interests in traditional medicine.
  • A Zambian man has died from herbs taken to cure infertility.
  • The creation of the AYUSH department in India has led to a call by “the Siddha fraternity” for stakeholders “to put a strong demand before the state government and to the central Ayush ministry for establishing a separate Ministry for Siddha.”
  • The first Mind, Body and Soul conference in Istanbul took place March 13-15, 2015.
  • President Pranab Mukherjee of the All Indian Ayurvedic conference speaks to how Ayurveda and Siddha are “believed to have” treated diseases like HIV and tuberculosis. He notes that “some modern hospitals are additionally offering Ayurveda in the name of integrative medicine.”
  • Chart gives state-by-state numbers of “manufacturing units” of traditional medicine in India. There are 9,000 total.
  • Research from the Institute of Traditional Medicine of National Yang-Ming University in Taipei suggests Chinese formula “Six Flavor Rehmanni” is useful for reducing kidney failure in people with type 2 diabetes. The study was a retrospective review of insurance records.
  • In the absence of Western medical help in a cholera outbreak in Nigeria, traditional medicine practitioners were “squeezing water from bitter-leaf and giving to our children to stop further vomiting and passing of stool.”
  • The Beijing Traditional Chinese Medicine and Western Medicine Cardiac Rehabilitation Center, the first of its kind in China, was recently established.
  • This is a lengthy interview with entrepreneur Shahnaz Husain (pictured) on the global Shahnaz Husain Group’s “concept of Ayurvedic beauty care and cure.” Husain pushes for a UN “Ayurveda Day” to go with the June 21 International Day of Yoga.
  • The Federation of Chinese Physicians and Acupuncturists Association of Malaysia says a number of traditional Chinese medicine schools have closed shop for failing to meet the requirements of the Malaysian Qualifications Agency (MQA).
  • “Eat, Pray, Leeches” is the title of this feature overview on the rise of AYUSH in India under Prime Minister Modi.
  • The National Association of Nigerian Traditional Medicine Practitioners (NANTMP) will have a March 23, 2015 summit “to discuss the way forward for traditional medicine practitioners in Rivers State.”
  • A relatively balanced look at the challenge to homeopathy in Australia.
  • A Global Times extract from Xinhua on Chinese government priorities includes a promise to “actively develop traditional Chinese medicine and the traditional medicine of ethnic minorities, and advance the reform of family planning services and the way they are managed.”
  • The American Botanical Council gave its annual publication award to a book on indigenous uses of herbs in the Pacific Northwest.
  • The department of integrative oncology was launched at India’s Mazumdar Cancer Centre, Narayana Health City (NH Health City).
  • This article in The Sowetan speaks to the growing numbers of South African whites who are exploring tradition African medicines and “magic.” An estimated 200,000 traditional healers are in the 53-million population.
  • The five animals pushed to near extinction in part due to their killing for traditional medicinal use are described in this One Green Plant blog.
  • In the United States, Columbia University professor Norman Doidge explores why “faith healing” and other traditional medicine practices may work.
  • Also in the United States, the Food and Drug Administration has announced a 2-day hearing to review its regulatory practices relative to homeopathy. See Global Integrator: Homeopathy on Trial (Again): Australian Report and Now USFDA April 20-21 Hearings.
  • Miao medicines are expected to be an economic driver for Guizhou in southwest China where modern labs now make traditional medicines.
  • The Daily Express of East Malaysia includes a note that there are more than 12,000 registered traditional products in a piece on “unscrupulous” behavior of unregulated traditional healers.
  • The Puyallup tribe in Washington State has announced plans for the first ever tribal-owned integrative oncology center in what will be a 8200–square foot facility (pictured).
  • An  Ayurvedic steam treatment less expensive than a spa is among the traditional medicines featured at the fair in India.
  • India has more than 2,300 spas generating $400-million in revenue and the market is growing 20% a year, according to this report.
  • Prince Charles’ visit to the United States provoked a diatribe from an anti-“CAM” and anti-homeopathy blogger David Gorski, MD, at Slate.
  • Malaysian traditional medicine practitioners are having a tough time with a new tax system.
  • TCM got a big boost for treatment of infertility from U.S. News & World Reports.
  • Traditional medicine exploration was promoted at the 2015 meeting of the Indian Society of Pharmacognosy.
  • This Chinese scientist is looking at mixing herbs with stem cells in regenerative medicine.
  • A yew bio-pharm group in China has signed a multi-million dollar agreement to make a yew extract for the US market.
  • This article is an interview about the development of a small Nigerian natural products company.
  • Tensions over the role of natural medicine sellers in Saudi Arabia are revealed in this article.
  • Taiwanese researchers report positive findings in a traditional medicine approach to reducing the risk of kidney failure in diabetes treatment.
  • This long feature explores the work of Kahuna Lapaau (Master Healer) Ikaika Dombrigues (pictured) who also serves as a consultant to the Hawaiian government on the Big Island.
  • This page includes Australian resources and scientists from an institute devoted to complementary and alternative medicine research.
  • The use of alcohol alone or with herbs as medicine among Kenyans is reported here.
  • An article on the surprise death of a Hong Kong woman following acupuncture treatment led an integrative medicine specialist to state that he “advise(s) patients who were pregnant, suffering from cancer or using anticoagulants to avoid acupuncture. Nor should acupuncture patients be too hungry, tired, or nervous.”
  • The opening of the first TCM clinic in Palestine is featured here.
  • The Wikwemikong Health Centre held a gathering titled “Celebrating and Achieving Mino Mbaadiziwin”—the good health; mind, body and spirit—exploring the intersection of indigenous and Western medicine. The Wikwemikong “unceded reserve” is next to southern Ontario, Canada. A long-time, recently deceased, Western-educated family doctor who practiced on the island is honored here.
  • This article on functional foods in a Goshen, Indiana, paper honors the traditional use of foods as medicine in Chinese medicine.
  • This Kashmir paper includes an article describing cupping, leech therapy, and other traditional methods.
  • Endangered medicinal plants are the feature of this story that touches on the creation of the National Medicinal Plants Board in the AYUSH Ministry.
  • A Canadian doctor, Karen Hill, MD, (pictured, center), who was instrumental in standing up for individual rights and aboriginal medicine for a family that did not wish to use chemotherapy, received an award from the Royal College of Physicians and Surgeons of Canada “for her dedication to bridging the gap between indigenous health values and the practice of western medicine.” The award decision was made prior to the highly publicized controversy.
  • Also in India, the JSS University, Mysor,e and the Centre for Science and Technology of the Non-Aligned and other Developing Countries organized a March 30-31, 2015 joint international training workshop on “herbal drug discovery: herbs—approaches, innovations and applications.”
  • The president of Tanzania’s Dedza Herbalists Association, Masiyambuyo Njolomole, has taken a strong position separating con men from traditional healers when it comes to trade in Albino body parts: “A true herbalist is supposed to protect life and not terminat[e] it.”
  • Potential health benefits of venom from Australian cane toads may turn what was viewed as an invasive pest into an export to China as a medicinal product.
  • In a turnabout from an earlier decision and against public wishes, the British deputy chief medical officer has decided to not register herbalists, claiming insufficient evidence that herbs work, despite support for the measure from Prince Charles.
  • This is a strong editorial arguing that the government of Indonesia needs to crack down on the sale of pig-nosed turtles for traditional medicinal and other purposes.
  • The traditional medicinal practice and customs of the Dayaks are at risk of getting into trouble if the Traditional and Complementary Medicine (TCM) Act 2013 is to be fully implemented this year.
  • A publication on Roseroot for depression stimulated many news accounts, including this.
  • The Indian government today gave its approval for signing of an agreement with Mauritius on cooperation in traditional medicine systems and homeopathy.
  • A $3 million grant will allow naturopathic physician researchers at Canadian College of Naturopathic Medicine and at Bastyr University in the United States to explore the value of integrative naturopathic care in cancer treatment.
  • This piece, Dr Prozac, Meet Dr Vodou, is a respectful look at the growing merging of traditional and pharmaceutical methods.
  • A Vietnamese man from a family of traditional medicine practitioners reaching back 400 years was honored for treatment of people from the most countries (102) with traditional Vietnamese medicine.

The Remarkable International Reach of Pizzorno-Murray’s Textbook and Their Encyclopedia of Natural Medicine

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BookI was recently charged to contact science-based natural medicine pioneer Joseph Pizzorno, ND, to see if he would donate a copy of the Textbook of Natural Medicine (NM) to an auction for an organization of integrative health and medicine practitioners in Puerto Rico. I was tapped to make the request as I had been his close colleague in the re-emergence of naturopathic medicine in North America from 1983-1993. The book, first published in 1985 by Pizzorno and his coauthor, Michael Murray, ND, is an icon. It was the first of its kind to link natural medicine as thoroughly as possible to existing scientific evidence for specific conditions. With globalization, the new sources of evidence were increasingly available. The original loose-leaf binder format (pictured) was meant to be responsive to the changing and already growing international evidence base. Pizzorno was then president of what would become Bastyr University. Murray was a 1985 graduate of the now thriving university’s founding program in naturopathic medicine.

In the course of the e-exchange, I asked Pizzorno for an update on sales of the textbook and the related volume that the two subsequently created for consumers, The Encyclopedia of Natural Medicine.  He shared that the Textbook has been thorough 4 editions with a total of 100,000 copies. Said Pizzorno:  “We decided to call the binder version of the Textbook of NM the first edition, even though it was updated around 30 times with new/revised chapters, growing from 1 volume to 2 over its 14 year run from 1985 to 1999.” The book, now in bound form, has been translated into Japanese, Italian, and Cyrillic. The encyclopedia has had 3 editions with a total of now more than 2,000,000 copies sold. The consumer-focused volume has been translated into Greek, Hebrew, Italian, Russian, Spanish, and Yugoslavian.

Pizzorno bowed to his co-author, Murray: “I don’t think many know how huge an impact Mike has had advancing this medicine not to just consumers but doctors as well.” He notes that most of the chapters in the textbook were written by Murray, starting with the first edition in 1985. Murray and Pizzorno have since each authored multiple books on natural health and medicine themes.

Comment: It is difficult to overstate the impact of these two volumes on the growth of integrative health and medicine. The impressive sales numbers for such reference texts evoke images of impact on person health via well-thumbed copies in clinics and homes worldwide. More important, in the mid-1980s, publicly linking natural medicine with science only happened in obscure pharmacognosy meetings and research divisions of pharmaceutical firms seeking to turn botanicals into pharma gold.  The very phrase “science-based natural medicine” that we began to use was a striking announcement of a nascent cultural blossoming. Today, we see many similar volumes. We are accustomed to hefty, thoroughly referenced texts and online resources on herbs, nutrition, energy medicine, nutritional supplements, healing foods, women’s health, integrative medicine, and more at one’s fingertips.

The influence of the two did not end there. Murray would become the best known exponent and spokesman for the standardized extract approach to botanical preparations with which he became linked as a businessman. Both books raised consciousness about these more research-ready herbal forms. I recall the 1985 Bastyr Executive Team meeting when Pizzorno proudly pulled the first copy of the first edition of the book out of its box as part of the ritual “News & Goods” portion of the weekly agenda. In such moments, paradigms creak—and shift.